Since a few weeks, I report the raw number of COVID-19 deaths in Maryland counties. If this gives an idea of the cumulative number of deaths – which is interesting – it doesn’t reflect the fact that some counties have more inhabitants than others. That’s why I plotted below the number of COVID-19 deaths adjusted for the population (i.e. the COVID-19-specific death rate):

(click to see more details)

Today (May 16, 2020), in terms of absolute number of deaths, Montgomery, Prince Georges and Baltimore County are the top 3 counties (this is the same for cases but not in the same order). In terms of confirmed deaths per 100,000 population, the top 3 counties are Kent, Prince Georges and Montgomery.

Following up on my two previous posts (here and here), I am writing a third post on COVID-19 in Maryland because I believe we enter a new phase.

Before continuing, please note that the same disclaimer as in my previous post applies here (in short: read the CDC and MDH websites for official information).

In the first phase, the importance was to detect and make sure COVID-19 patients were treated (also: make sure not to overwhelm the healthcare system, flatten the curve, lower the baseline, & stay at home!). My two previous posts were following these efforts, thanks to daily data released by the Maryland Department of Health (MDH) on its dashboard. My second post will still be updated with the latest data from there, go read it!

This first phase is not over yet but we started to see metrics states and governments will consider in order to “reopen”. Hence this second phase is adding specifically these metrics, again thanks to the Maryland Department of Health (MDH) on its dashboard (and probably other data sources that will be linked as I use them).

In Maryland, the Governor issues a Roadmap to Recovery on April 24, 2020. In this (easy to read) document, a lot of aspects are introduced and here is what will be tracked and for how long:

“state public health officials should review the numbers of new COVID-19 daily case counts, hospitalizations, and deaths carefully” and “The results of reopening decisions will take 2 to 3 weeks to be reflected in those numbers.“

“the White House’s gating guidelines state that a 14-day downward trajectory of benchmark metrics – or at least a plateauing of rates – is required before recovery steps can begin, and before each additional recovery step can move forward“

That’s why Governor Larry Hogan tweeted his focus on April 24:

The key numbers we are most focused on are on the rate of hospitalizations and the number of patients admitted to ICU. If these numbers continue to plateau, Maryland could be ready to begin the recovery in early May. This data is updated daily at https://t.co/Shy9A0czWz.

States should consider initiating the reopening process when (1) the number of new cases has declined for at least 14 days; (2) rapid diagnostic testing capacity is sufficient to test, at minimum, all people with COVID-19 symptoms, including mild cases, as well as close contacts and those in essential roles; (3) the healthcare system is able to safely care for all patients, including providing appropriate personal protective equipment for healthcare workers; and (4) there is sufficient public health capacity to conduct contact tracing for all new cases and their close contacts

On April 27, 2020, this is what we currently have … On the first chart, the number of positive tests is increasing (probably due to the increase of testing done), hospitalizations and deaths are slowly going up, overall. On the third chart, it seems the number of people in ICU is plateauing. Below these charts, I’ll post the updated charts as days are passing …

Statbel, the Belgian governmental organisation for data and statistics, just released mortality data for 2014 (press release in French, dataset). The headline of their press release was that, for the first time, tumors were the first cause of death for Belgian men. Diseases of the circulatory system remains the main cause of death in Belgium, for women and for both sex together.

While the death of someone is a bad news in itself, I’m more interested here in the evolution of death causes. I’m interested in the evolution of causes of death because it might be a consequence of the evolution of the Belgian society and, as a proxy, of any (most) developed, occidental countries.

If you look at the data, the number of Belgians dying is stable and natural death is still the main cause (and also stable, around 93%). Note that if we look at data before 2010, it seems that mortality is slightly increasing since around 2005.

If the total number of deaths seems stable, the press release seemed to indicate that tumors (cancers) are on the rise, especially in men. The breakdown in categories is made following the international classification ICD-10 and, because the names of the different chapters are quite long for graphs, I will use the corresponding chapter numbers instead. Here is the key:

Chapter

Header

I

Certain infectious and parasitic diseases (A00-B99)

II

Neoplasms (C00-D48)

III

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)

IV

Endocrine, nutritional and metabolic diseases (E00-E90)

V

Mental and behavioural disorders (F00-F99)

VI

Diseases of the nervous system (G00-G99)

VII

Diseases of the eye and adnexa (H00-H59)

VIII

Diseases of the ear and mastoid process (H60-H95)

IX

Diseases of the circulatory system (I00-I99)

X

Diseases of the respiratory system (J00-J99)

XI

Diseases of the digestive system (K00-K93)

XII

Diseases of the skin and subcutaneous tissue (L00-L99)

XIII

Diseases of the musculoskeletal system and connective tissue (M00-M99)

One thing to notice is that, for chapter IV, Statbel only counts categories E00 to E88 while the WHO includes 2 more, from category E00 to E90 ; I would assume here that it has no important impact. Also note that, below, R ordered the chapters in a strange way – I’ll see how to fix that.

Excluding natural causes, we see that indeed, diseases of the circulatory system (chapter IX) are still the first cause of death, followed by neoplasms (chapter II) and diseases of the respiratory system (chapter X). If we compare the relative ratio of all these causes (second graph below), we also find the same conclusion – but the relative decline in deaths due to diseases of the circulatory system is better shown. And we can see that neoplasms take back approximately the same relative percentage of death, in 2014 (although they returned to the absolute number of deaths of 2012, approximately).

The available data set doesn’t go into more details than numbers by ICD-10 chapters. Therefore we cannot tell from that what kind of neoplasm is the most prevalent or what kind of infectious disease is the most present in Belgium, for instance. The press release however mentions that respiratory, colorectal and breast cancers are the top three killers and that flu was not very present in 2014.

As the cancer occurrence is increasing with age, and as the Belgian population is aging, one of the explanation for a high number of deaths due to neoplasms can be age ; however we don’t see a dramatic increase of neoplasms (fortunately!). Another potential factor is the impact of screening for cancers. Due to a very intelligent political split (sarcasm!), prevention (and therefore screening) is not a federal duty. Therefore regions started different screening programs, at different times, with different results. Screening data and their results are therefore difficult to obtain. The Belgian Cancer Registry doesn’t publish data on screening in oncology – although its latest report (revised version of April 2016) very often mentions screening as a main factor for change in the number of cases diagnosed. In its 2016 report (PDF), the Flemish Center for the Detection of Cancer (Centrum voor kankeropsporing) indicates that they increased the number of women screened for breast cancer by more than 8% between 2011 and 2015 (especially in 2015), with a quality of test between 90% and 95%. They also showed an increase in cancer diagnostics (without linking it directly to the increase in screening).

This is by no means an exhaustive review of the data. There are other potentially interesting things to look at: the geographical disparities between the three regions, the gender ratio evolution (as some of these diseases are known or by definition affecting more one sex than the other), etc.

It would also be interesting to follow these trends as some changes occurred recently in the Belgian curative landscape. New drugs in cancer immunotherapy were recently authorised and reimbursed, for melanoma, lung – and other indications will follow. These costs have a price (less than what is in the press, however, I may come back on this in a future post) but they delay death (unfortunately they don’t avoid it). However, for some of them, in some indications, their administration and reimbursement is sometimes also linked with screening, testing and prior treatment failure ; that might decrease their impact on overall mortality. New drugs for Hepatitis C also arrived in 2015 and 2016 and the Belgian health minister decided to reimburse these drugs for patients in their early stage 2 of the disease. Studies showed that treating at this stage may prevent hepatitis C from progressing to later stages and, in some cases, studies showed patients cured from the disease. This is an opportunity to see a decline in mortality due to this infectious disease (although it is already quite low – compared to other diseases).

From Delicious, I saw that Yahoo had an article about the top 5 killers of men. I thought it would be nice to see from where they get there data.

First, I have to mention that the article is really about American men, nothing else (not about mankind, not about men around the world, not about women, children, etc.). The article is related to the US National Men’s Health Week (the US National Women’s Health Week was in May 8-14, 2011). Although the article is giving advices, there are no sources of information.

All of them causes more than 45% of deaths around the world. These diseases with high-mortality vary in an important manner when we compare the USA and the whole world. The main caveat is that the data I presented above are for men and women. It would be interesting to use the UN data API project to dig further into details.

I wish for your help to create a strong, sustainable movement to educate every child about food, inspire families to cook again and empower people everywhere to fight obesity.

Although I have a child and I’m obviously interested in his idea, I was also interested in the simple bar chart depicting the leading causes of death in the USA. In the tiny Flash video, the text is unfortunately barely legible and I was interested in knowing where he got his data from.

The answer is really easy: the leading causes of death in the USA are compiled every year by the (American) National Center for Health Statistics and the results are available on their FastStats website. So, for 2007 (the latest results at the time of writing), the 15 leading causes of death in the USA are (ordered by decreasing number of cases):

Rank

Cause

Number

1.

Diseases of heart *

616,067

2.

Malignant neoplasms (cancers) *

562,875

3.

Cerebrovascular diseases *

135,952

4.

Chronic lower respiratory diseases

127,924

5.

Accidents (unintentional injuries)

123,706

6.

Alzheimer’s disease

74,632

7.

Diabetes mellitus *

71,382

8.

Influenza and pneumonia

52,717

9.

Nephritis, nephrotic syndrome and nephrosis

46,448

10.

Septicemia

34,828

11.

Intentional self-harm (suicide)

34,598

12.

Chronic liver disease and cirrhosis

29,165

13.

Essential hypertension and hypertensive renal disease

23,965

14.

Parkinson’s disease

20,058

15.

Assault (homicide)

18,361

The exact ICD-10 codes are in this report ; you can find their exact meaning here. Causes with an asterisk are related to food intake, according to Jamie Oliver.

Now you have the numbers, the origin of the data and the methodology used to collect these data. You can watch the presentation: